Welcome to the Wellness Roadmap!

Please allow yourself a quiet space and some time to complete this survey.

It shouldn't take more than 10-15 min.

If you don't feel comfortable answering a question, just type "no" and move one.

The more info you provide, the better I'm able to support you.

Your answers and completely confidential.

Full Name *

Email *

Phone *

Let's begin!

Date of birth *

Height

Current Weight

Do you have any medical conditions you wish to disclose? (I.E. diabetes, hypothyroid, high cholesterol, etc) *

Can you describe your familiarity with menopause? *

Are you currently experiencing any bothersome symptoms of menopause? *

Yes

Not sure

If you answered yes to the previous question, which symptoms are most bothersome?

Goal Review Section

Which of the following best describes your goal with your fitness and nutrition? *

I'd like to feel more confident in my own skin.

I'd like my clothes to fit better.

I'd like to build muscle and get stronger.

I'd like to be healthy and live longer.

I'd like to heal and improve my relationship with food.

What do you think is the biggest obstacle or frustration that is keeping you from reaching that goal? *

How long has this goal felt unattainable? *

What would it mean for you to solve this problem? *

How much progress are you making with your current fitness and nutrition plan? *

I don't have a plan right now.

It's very slow and frustrating.

Some progress but room for improvements.